WO2003051195A1 - Dispositif universel de positionnement d'electrodes d'ecg pour quatre tailles dont extra-large, et procede associe - Google Patents

Dispositif universel de positionnement d'electrodes d'ecg pour quatre tailles dont extra-large, et procede associe Download PDF

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Publication number
WO2003051195A1
WO2003051195A1 PCT/US2002/039495 US0239495W WO03051195A1 WO 2003051195 A1 WO2003051195 A1 WO 2003051195A1 US 0239495 W US0239495 W US 0239495W WO 03051195 A1 WO03051195 A1 WO 03051195A1
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WIPO (PCT)
Prior art keywords
sensor
positions
mask
patient
sensors
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PCT/US2002/039495
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English (en)
Inventor
William K. Wenger
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Unilead International Inc.
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Priority to AU2002362129A priority Critical patent/AU2002362129A1/en
Publication of WO2003051195A1 publication Critical patent/WO2003051195A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/282—Holders for multiple electrodes

Definitions

  • the present invention relates to a disposable dermal chest mask for assistance in establishing electrical communication between sensors on a human chest and electrocardiograph machines. More particularly, it relates to a universal electrocardiogram sensor positioning device and method for all adult sizes including size extra large. DESCRIPTION OF THE PRIOR ART
  • Diagnostic medical equipment increasingly relies upon electrical contact with specific areas of the human body for evaluating the health status of patients.
  • One of the most utilized and relied upon diagnostic tools is the electrocardiogram, sometimes referred to as an ECG.
  • Leads or signal wires from the analytical apparatus are attached to a metallic or otherwise conductive body sensor electrode which is attached to the patient's skin at the desired points of contact.
  • Electrical current generated by the heart in a person's chest flows to the surface and at the skin produces differences in electrical voltage which can be measured between pairs of electrodes placed at two points on the skin.
  • a twelve-lead electrocardiograph provides the most accurate signals for recognizing ischemic electrocardiographic changes.
  • Electrodes To administer a resting twelve-lead ECG, it is necessary to apply ten electrodes to various points on the torso and limbs of a patient to measure and analyze cardiac data. Twelve recordings for the ECG are made from nine active lead positions with the tenth being used as a ground. An electrode portion of a lead may in fact consist of an alternative form of sensor, and the terms "electrode” or "sensor” for purposes of this disclosure are interchangeable. A lead wire connecting a sensor to the diagnostic equipment could possibly in fact consist of a radio or an optical signal. Six of the ten electrodes are applied to the patient's chest over prescribed anatomical landmarks. The remaining four electrodes are applied to each of the patient's limbs.
  • the chest electrodes are known as the precordial leads and the limb electrodes are called limb leads.
  • the precordial leads are designated V 1? V 2 , V 3 , V 4 , V 5 , and N 6 .
  • the limb leads are designated LA, RA, LL, and RL (ground). It is generally acknowledged that it is critically important to place the precordial leads with precision in order to obtain accurate and repeatable recordings. However, accurate placement and attachment of a large number of leads can be difficult and time consuming and requires knowledge, skill, and diligence on the part of the person attaching the electrodes or sensors. Mechanical problems in attaching multiple leads to a patient range from tangling of lead wires, and excessive time consumed in pairing lead wires with the appropriate electrodes, to difficulty in locating anatomical landmarks on a patient with precision.
  • precordial leads placed one inch or more from their true anatomical landmarks can result in misinterpretation of the patient's ECG. This may result in or contribute to diagnosis errors, false hospital admissions, sending sick people home, or have other negative impacts on diagnosis or treatment.
  • the placement problem is compounded when serial comparisons are made between two or more ECGs taken over time. For example, if N 4 was placed one inch too high for one test and one inch too low for another, the difference of two inches may produce what appears to be a significant difference between the two ECGs when in fact there was no physiological change in the patient's heart condition.
  • precordial leads To place the precordial leads accurately requires training in using both visual and palpatory cues to find the anatomical landmarks pn each patient. Placement accuracy is also affected by the time and diligence dedicated to placing the precordial electrodes. An experienced and conscientious electrocardiologist may require and devote ten minutes to palpation and ascertaining the exact precordial landmarks. However, in busy clinical environments or emergency situations, medical personnel are often so rushed they may not even palpate the patient. Under those conditions, precordial leads are commonly placed with inadequate palpation and with little attention to a patient's particular anatomy. As a consequence, individual leads are often misplaced by two and as much as three inches from their true anatomical landmarks.
  • Each lead wire is labeled to correspond to one of the anatomical landmarks, i.e., N l7 N 2 . . . N 6 . . . RL.
  • interpretative ECG monitors can detect and alert the operator of a possible crossed lead wire situation, but that requires additional time to check connections and to take corrective action. This is a time consuming operation which increases the risk in an emergency situation.
  • Crossed lead wires are a more significant problem when the ECG monitor does not provide interpretation of the recordings and cannot alert the operator of this possibility.
  • the ECG signals for each of the twelve leads are recorded on hard copy to be read at a later time.
  • the physician or technician reading the ECG recordings may recognize the error but by that time the patient has usually been disconnected from the monitor.
  • the present invention reduces or eliminates the chances of either of these situations from occurring.
  • Periodic electrocardiograms are important for providing a cardiographic profile of a patient for early detection and diagnosis of cardiovascular diseases. In order to provide an accurate profile, it is important not only that the electrocardiogram be taken with sensors affixed accurately, but that the sensors be placed at the same location on the patient in the subsequent exam as for the previous examination. The efficacy and the repeatability of the tests is critical so that a series of ECG results can be compared to provide a continuing profile of a patient's medical history for diagnosis and treatment of heart disease.
  • the common invention in those patents is a disposable electrode positioning device and utilizes a non-conducting flexible sheet in the form of a mask having a predetermined dimensional sensor array.
  • the flexible sheet serves as a template for aligning connectors or sensors, either of the electrode or electrodeless type, on the chest of a patient for transmitting electrical impulses.
  • the flexible non-conductive sheet is provided in a plurality of sizes, with each size having arrays V ls V 2.
  • N 3 and N 4 at substantially the same locations and having arrays N 5 and N 6 at different locations depending on size.
  • the locations of N 5 and N 6 are based on a measured distance between the left midclavicular line and the left midaxillary line on the chest of a patient.
  • the dimensional array on the flexible non-conductive sheet is provided with cutouts to form a template or mask which is placed on the patient's chest and then conventional electrodes can be positioned in the cutouts.
  • the template can be provided with a plurality of conventional tab, snap, or other electrodes affixed on their top sides to the flexible sheet to be placed against the patient's chest. The electrodes are positioned in accordance with the predetermined dimensional array. Small cutouts, or openings, in the template expose the electrode tabs for attaching lead wire clips. Snap electrodes protrude through the template to permit the attachment of lead wire snap connectors.
  • the top sides of individual electrodes can be lightly affixed to the flexible sheet of material at the predetermined dimensional array locations.
  • the sheet can be placed on the patient's chest and then peeled away leaving the electrodes properly located on the chest.
  • Yet another aspect of the Kelly inventions is a method of sizing a patient for fitting a sensor positioning device having a flexible sheet with a fixed dimensional V l - V 6 array positioned in a specific size configuration appropriate for standard electrocardiographic recording.
  • the distance between V t and V 2 is a predetermined distance plus or minus a small amount
  • the distance between V 2 and V 4 is a predetermined distance plus or minus a small amount
  • V 3 located substantially midway between V 2 and V 4
  • N 5 being equidistant between N 4 and N 6 .
  • the method of sizing the disclosed related inventions comprises the steps of measuring the distance between the midclavicular line and a midaxillary line on the chest of the patient, and selecting a positioning device size of those inventions based on the measured distance.
  • This procedure is eliminated by the related application, the '125 patent, and the present invention.
  • the prior art U.S. Patent No. 4,583,349 to Manoli and the U.S. Patents to Kelly describe precordial electrodes fixed in a preset pattern on a flexible sheet in positions corresponding to the anatomical landmarks on the patient.
  • the basic problem with all of these inventions is that they require multiple sizes of sensor positioning devices to fit various sized persons.
  • Manoli envisions, without stating any dimensions, three sizes—a pediatric, medium adult, and large adult— to fit most children and adults within the population. Kelly describes three sizes— small, medium, and large adult—to fit most adults within the population. Manoli does not describe how one determines which size device a patient would require. Presumably, under Manoli, a small person requires the smallest of the three sizes, i.e., the pediatric, and a large person requires the largest.
  • the invention disclosure is indefinite in this regard.
  • Manoli does not describe how to size a patient, and it is common for persons placing individual electrodes to make errors. If similar errors are made when sizing the patient for Manoli's device, it is quite likely that the wrong size device would be selected. Once a device is applied to the patient, it would be possible to check the correctness of fit. If wrong, however, i.e., the V 6 electrode was located some distance from the patient's midaxillary line, the device would have to be removed and replaced by a more appropriate size device. This trial and error approach wastes time and materials since the first device would need to be discarded without ever being used to take an ECG.
  • U.S. Patent No. 5,678,545 to Stratbucker describes an adhesive sheet having a -fixed array of individual electrode groups disposed at varying locations to provide a "one size fits all" system.
  • One embodiment has twelve precordial electrodes with one electrode each at N l5 V 2 , and N 3 and groups of three electrodes each at N 4 , N 5 , and N 6 , while other embodiments are suggested for groups of electrodes for other electrode locations
  • Stratbucker describes multiple groupings of electrodes for a "single size" system but it is necessary to determine which electrode in each group is within the region of the appropriate location on a patient's chest: for each group of electrodes, there must be a determination of which electrode is closest to the anatomical landmark. Such a determination is time consuming and would at least be impeded by the fact that palpation will be difficult to perform once the sheet is placed over a patient's chest.
  • each group of electrodes provides a source for error since there are three electrodes to choose from in each group. Assuming one electrode in each group is most correct, the probability of randomly selecting the best electrode from each of the groups is .33 , where X equals the number of groups.
  • N 4 , N s , and N 6 consist of groups of three electrodes each
  • the probability of randomly selecting the appropriate electrode from each group is .037, or 1 out of 27 possibilities.
  • Stratbucker relies on a judgment determination for each group of electrodes and therefore selection is time consuming and inexact due to the device physically covering the patient's anatomical features.
  • U.S. Patent No. 6,006,125 uniquely solved those problems by providing a multiple precordial array of sensor electrodes in a single device that will fit essentially three classes of sizes of adults and in which sizing is accomplished simply by the determination of the location of a single sensor which is closest to a selected anatomical landmark. This is achieved by a device having more precordial sensors than the six chest electrodes needed for the resting ECG but significantly less than the number of those taught by Stratbucker.
  • some sensors may serve multiple roles to accommodate different patient sizes within one array by utilizing a particular set of sensors.
  • Each set of sensors corresponds to a specific patient size that can be characterized as small, medium, or large.
  • the present invention differs from prior art parent U.S. Patent No. 6,006,125 described in the related applications portion of this specification to provide a significant advantage.
  • the '125 patent covers three classes of human torso sizes which, by accurate estimate, includes ninety percent (90%) of the adult population and a substantial portion of the teenage population. The ten percent (10%) of the adult population not covered are the extra-large persons of which there is a substantial representation in the human population.
  • the present invention provides a unique modification to the '125 patent which accommodates nearly all of the extra-large size torsos whereby the present invention will fit an accurately estimated ninety-nine percent (99%) of the adult population as well as a substantial portion of the teenage population.
  • the present invention is a universal ECG multiple sensor dermal precordial mask for fitting different sizes of human bodies including extra large for obtaining electrocardiographic information using sensors V l5 V 2 , V 3 , V 4 , V 5 , and V 6 .
  • the mask comprises a sheet of non- conductive material incorporating at least ten sensor positions forming four sets of sensor groups including four alternate positions for each V 5 and V 6 positions.
  • the ten sensor positions are disposed a specific geometric arrangement with the V x - V 4 positions being utilized for all sizes of bodies.
  • the N 5 and N 6 positions have first and second independent sensor positions each and first and second shared positions.
  • the present invention also includes a method for obtaining electrocardiograms by means of a universal ECG multiple sensor dermal precordial mask incorporating sensors N l5 N 2 , N 3 , N 4 , N 5 , and N 6 for fitting different sizes of human bodies including extra large.
  • the method comprises the steps of providing a mask having at least ten precordial sensor positions forming at least four sets of sensor groups including four alternate sensor positions for each of the N 5 and N 6 sensors.
  • the ten sensor positions are disposed in a specific geometric arrangement with the V x - N 4 sensors being utilized for all sizes of bodies.
  • the N 5 and N 6 positions each have two independent sensor positions and share two positions.
  • the mask includes indicia for determining which sensor positions correspond to the four sensor sets.
  • the mask is aligned on a patient's chest so that the N x and N 2 sensors are disposed approximately on opposite sides of the patient's sternum. It is ascertained from the indicia which of the four N 6 sensor positions lies on or is closest to the patient's midaxillary line, and then electrocardiographic information is obtained from the corresponding set of sensors which include the N 6 sensor.
  • FIG. 1 is a plan view of the Universal ECG Sensor Positioning Device of the present invention.
  • FIG. 1 illustrates a plan view of the universal disposable ECG sensor positioning device of the present invention for placement on the chest of a patient for performing an ECG test.
  • the word "universal” as used in describing the device is an abbreviation of the descriptive colloquial terminology— one size fits all.
  • the devices of the related inventions fit ninety-nine percent (99%) or more of the adult population and most older children as well.
  • the term "disposable" means that the device is intended for a single or one time use only. However, the physical form of the device could be reusable for more than one test, and a more permanent embodiment of the design could be a truly reusable device possibly requiring sterilization, cleaning, and/or fresh adhesive for reuse. Therefore, the term "disposable,” as used in the descriptive preamble of the claims, is provided solely as an aid for most accurately describing the preferred embodiment of the invention in relation to the prior art and should not be interpreted as a limitation on the forms of the invention and scope of the claims.
  • the device is a dermal chest mask 11 which is formed of a sheet of flexible nonconducting material 13 for carrying or positioning ten chest electrodes or electrodeless sensors 15, or simply holes therein for the positioning thereof, for connection by electrical lead wires (not shown) to a standard electrocardiographic diagnostic machine.
  • the alternate means for sensor placement is designated in the claims hereof by the term "sensor positions" which includes all of the aforementioned means for sensor placement.
  • the flexible non-conductive web or sheet may be formed from any preferably transparent natural or synthetic material which is capable of accepting a print.
  • any cellulosic material, polyester, polyolefin, polyvinyl chloride, nylon or mixtures thereof would be suitable.
  • Cotton, polypropylene, or polyethylene can be used if cost is a consideration. However, polyester is likely the most preferable.
  • Detachable limb lead sensors 17 can also easily be provided integral to the mask during the manufacturing process. In a preferred embodiment, they are formed integral to the mask with a means for easy detachment such as a set of perforations along the line of joinder 19 of the Umb lead sensor to the mask 11. The ends of the limb lead sensors are provided with an electrical contact area 21 whereby an electrical lead can be connected to the sensor by any appropriate means such as an electrical connector clip.
  • the receptor sensor electrode positions 15, which are located on the mask 11, are spaced relative to each other in a specific geometric configuration appropriate for electrocardial recordings from all sizes of adult human torsos.
  • Each receptor sensor or electrode position is adapted for electrical connection with the skin of a patient's body for detecting and transmitting electrical signals generated by the patient.
  • the preferred embodiment of the mask includes conductor strips 23 each of which extends to and electrically connects to a sensor. The other end of each conductor strip terminates in a connector end or terminal which engages any type of connection or cable junction for electrical connection with the electrocardiograph analyzer. Separate leads could be utilized for a locator mask which simply provides sensor positions.
  • the four discrete electrical contact or terminal area groups are provided for connection to an ECG machine to accommodate four different classes of adult human torso sizes.
  • the four individual terminals 25 for N x to N 4 are contiguous, and six discrete terminals 27 are provided for N 5 and N 6 in four sizing configurations.
  • terminal ends of the strips are preferably disposed adjacent to each other in four identical paired patterns to facilitate connection to a common connector which can be utilized for all four classes of sizes.
  • a customized chp is envisioned to simplify use of the mask of the present invention by permitting a single-clip connection. Pin locator cut-outs 29 and indicia 31 for the clip allow it to be selectively engaged to the mask for connecting a certain or selected set of six sensors to the ECG machine.
  • a biocompatible electrically conductive adhesive such as hydrogel
  • hydrogel is applied to the body contacting side of the sheet at each sensor site for adhesion to the skin of the patient. It is generally transparent and shown in outline 16 in the drawings. Hydrogel is commercially available as are other suitable conductive adhesives and any suitable electrodermal adhesive would serve the purpose. The size of the adhesive area is generally between 3 and 9 square centimeters.
  • the gel-coated adhesive area of the mask 11 includes at least one release liner in releasable adhesive contact with the gel covering the sensors 15. Because the release liner can be transparent, and is simply a sheet of material, it is not shown in the drawings. Separate release liners could be provided for each sensor, but in the preferred embodiment, a single release liner covers all of the sensors and the mask can be removed from the liner in a single operation to expose all of the sensors as a unit (except for the limb lead sensors). The limb lead sensors 17 are released individually having been separated at the perforations 19 along the line of joinder with the mask.
  • the flexible release hner covering the receptors may be made from a suitable dielectric film or coated paper which includes polypropylenes, polyesters, olefinic polymers, polyvinyl chloride and its copolymers, acrylic rubbers, ABS resin, and the like. Commercial suppliers for these materials are listed in the related applications.
  • the receptor electrodes 15 and the conductor strips 23 can be produced from any electrically conductive material, e.g., metal, foils, conductive polymers, graphite, carbon fibers, and the like. They include gold, copper, silver, tin, aluminum, N-vinyl pyrrolidone, and alloys or mixtures thereof.
  • the receptor/ conductors can also be made from a conductive paste of a metal in particle form in a suitable binder which is printed or silk screened onto the flexible non-conductive sheet or electrolessly deposited.
  • a connective polymer may be heat pressed or otherwise conventionally secured to the web or sheet.
  • Copper strips could be utilized and electrolessly deposited on the polymeric sheets in a range of thickness from about 0.25 to about 5 microns, more preferably from 0.25 to 1.5 microns, and most preferably 0.4 microns in thickness.
  • a metallic ink may be preferable such as a commercially available silver ink.
  • Each of the conductor strips are less than 10, and preferably less than 5, micrometers in thickness, whereby the flexibility of the connector and adhesion of the gel surface to the skin are substantially enhanced.
  • the exposed conductive strips 23 may be partially covered with a dielectric layer for insulating the conductive pathways.
  • This coating can be transparent and is also shown in the drawings in outline 24.
  • the strips are coated with a dielectric polymeric material in such a way so that only selective portions comprising the sensor 15 and the electrical contact or terminal areas 25, 27 are exposed.
  • Suitable dielectric coatings include polyesters, ethylene- vinyl acetate copolymers, polyvinyl chloride and its copolymers, terpolymers such as acrylonitrile-butadiene styrene (ABS resins) and inter alia.
  • a preferred laminate for the flexible sheet of the invention can comprise several layers, several of which can be transparent.
  • a preferred embodiment of the invention would include: ( 1 ) a base layer of a flexible non-conductive film of polyethylene terphthalate;
  • a conductor strip comprised of silver ink
  • an adhesive layer such as hydrogel superimposed upon the silver ink in the sensor areas of the mask, or alternatively, a dielectric layer superimposed upon the silver ink in the conductor strip area of the mask
  • a flexible release liner as the top layer superimposed upon at least the adhesive layer of the
  • the sheet material of the mask contains designator markings or indicia to simplify attaching to or positioning of the mask on the patient's chest. It is sufficiently self-describing such that it allows a person untrained in electrocardiography to position the mask to obtain highly reliable and repeatable ECG signals. It also includes indicia for sizing the patient.
  • FIG. 1 shows the ten-sensor array which includes singular N 1? N 2 , N 3 , and N 4 sensor positions and four alternate N 5 and N 6 sensor positions.
  • the N 5 and N 6 positions each have two independent sensor positions (N 5S , N 5M , V ⁇ , and N 6XL ) and share two positions (N 5L /N 6S and N 5 /N 6M ).
  • FIG. 1 also shows the indicia therefor.
  • Indicia Nl, N2, N3, and N4 indicate a single position for each of the N l5 N 2 , N 3 , and N 4 sensors.
  • Indicia N5S indicates N 5 small;
  • N5M indicates N 5 medium, N5L/N6S indicates either N 5 large or N 6 small.
  • N5XL/N6M indicates either N 5 extra large or N 6 medium.
  • N6L and N6XL correlate to N 6 large and extra large, respectively.
  • the S, M, L, and XL indicia are provided to aid in selecting which set of sensors are to be utilized.
  • the additional indicia between Nl and N2, and N6M and N6L, aid the user in positioning the mask.
  • the indicia 31 proximate the pin locator cut-outs 29 aid in selecting the electrical connection for sensor set selection.
  • Ten sensors 15 are arranged in a precordial sensor array of four sets of six sensors each in which certain of the sensors serve the same function in each of the four size sets of six and at least two of the sensors serves as different designated sensors in the four different sets.
  • the ten precordial sensors are disposed in a specific universal geometric arrangement rather than in predetermined fixed arrays of individual classes of sizes of sensor groups, as taught in the related cases and the Kelly and Manoli patents, or in multiple all-inclusive sensor group arrays as taught by the Stratbucker singular patent. Nor are they positionable in an arbitrary individually located array of six precordial sensors as would be placed by a technician for a resting ECG.
  • ten sensors form four sets of sensor groups including four positions for each of the V 5 and V 6 positions in which two sensor positions serve for either N 5 or N 6 in four different sensor sets whereby four sets of six sensors each are provided by the ten sensors to position six of the sensors proximate to the anatomical landmarks of four different classes of human torso sizes including extra large.
  • the sensor positions 15 are disposed on the flexible sheet 13 which is designed to adhere to a human torso so that the receptor sensors are located upon the precordial area of the chest and above the epigastric region of the abdomen.
  • the flexible sheet can be essentially transparent and also includes self-explanatory indicia 33, 35 for aligning the mask on both the centerline of the patient's sternum and on the fourth intercostal space, respectively, whereby at least four sets of sensor positions on the mask, comprising six sensors each, accommodate four different classes of human torso sizes.
  • the indicia also provide for selecting the correct set of sensor positions for the torso size and show which sensors are to be used.
  • Indicia 29, 31 for the electrical connections to the ECG machine are also essentially self-explanatory and are accordingly based on the selected torso size of the patient.
  • the precordial indicia indicate which sets of sensors correlate to which torso size and that two of the sensors are shared or utilized for four classes of torso sizes but numbered as different designation sensor positions, V 5 or N 6 .
  • the position of the receptors at N x and N> are disposed to lie approximately on opposite sides of the patient's sternum at the fourth intercostal space as shown by the indicia 33, 35.
  • the receptors at N 3 and N 4 are attached over the ribs, with N 3 positioned approximately equidistant between N 2 and N 4 , and with N 4 positioned approximately over the intersect of the fifth intercostal space and the left midclavicular line.
  • the receptors at N 5 and N 6 are placed at the side of the torso so that N 5 is substantially midway between N 4 and N 6 .
  • the measurement of this distance is determined by having the applying technician measure, such as by using his/her thumb and the middle finger, the distance between the midclavicular line and the midaxillary line on the chest of the patient. This distance is then compared to a sizing scale to select the proper size of device.
  • the present invention does not require any type of intermediate step to determine a patient's size. Rather, the device is applied to the patient and a simple visual observation ascertains which of four N 6 sensors lies closest to the patient's midaxillary line to establish that patient's size and the selection of the corresponding sensor set.
  • the distance between N 4 to N 6 varies within predetermined limits based on the size of the torso.
  • the distance between N 4 and N 6 can range from about 2.5 to 4.5 inches; for the medium size, the distance can range from about 4.0 to 6.0 inches; for the large size, the distance can range from about 6.0 to 8.0 inches; and, for the extra large size, the distance can range from 8.0 to 12.0 inches.
  • sensors N 1? V 2 , N 3 , and N 4 are positioned the same for all sizes of torsos.
  • the center of N x is located on a point generally about 2.0 inches from the center of N 2 approximately on the 270 degree radial from the center of N 2 wherein the radial is measured with zero degrees measured from north at the top of N 2 .
  • the center of N 4 is located on a point generally 3.5 inches from the center of N 2 approximately on the 125 degree radial from the center of N 2 .
  • the center of N 3 is in line with N 2 and N 4 and is located on a point substantially between the center of N 2 and the center of N 4 .
  • the receptors N s and N 6 have four alternative positions each: all of the positions being disposed in the 90 degree radial from N 4 .
  • the centers of the N 5 positions are located approximately 1.75, 2.5, 3.5, and 5.0 inches from N 4 and the centers of the N 6 positions are located approximately 3.5, 5.0, 7.0, and 10.0 inches from N 4 whereby the centers of both N 5 and N 6 which are both located approximately 3.5 and 5.0 inches fromN 4 share a common sensor in different sets of sensors.
  • the table below corresponds to the determined measurements for electrode placement which are all inherent in the present invention. It shows the preferred dimensional layout for N s and N 6 relative to N 4 for different sized torsos. Obviously, small variations in the lengths of the measurements are within the scope of the invention:
  • N. and N 2 The distance between N. and N 2 is 2.0 inches, the distance between sternum centerline and N 4 , along a horizontal line is 3.85 inches, and the distance between N 2 and N 4 along a vertical line is 2.0 inches, although this vertical distance could be up to 3.5 inches without considerably altering the effectiveness of the device.
  • N 3 is located on a diagonal line between N 2 and N 4 , and is equidistant from N 2 and N 4 .
  • the mask of the present invention provides a plurality of connectors or terminals arranged in a predetermined dimensional array V x - N 6 on the flexible sheet which inherently observes the dimensions dictated by Table I.
  • the dimensional array on the flexible sheet becomes universal and the specific size configuration of the dimensional array or layout on the flexible sheet is dete ⁇ nined in the same manner as for multiple sizes of masks to permit the production of an accurate electrocardial recording during ECG testing which can be reliably repeated.
  • the ten sensors are positioned on the sheet in a geometric pattern approximating the standard precordial anatomical landmarks of any adult human being.
  • the positioning of sensors N x - N 4 is the same for all sizes of torsos and is shown in FIG. 1 as Nl, N2, N3, and N4.
  • the N 5 and N 6 positions each have four alternate positions including two independent sensor positions each: N5S and N5M for N 5 , and N6L and N6XL for N 6 . They also have two shared positions: N5L N6S and N5XL/N6M. All of the N 5 and N 6 sensor positions he along the same line with, and are spaced from, the N 4 sensor.
  • the first independent N 5 alternate sensor position N5S disposed closest to the N 4 sensor position N4, is utilized along with a first shared N 5 and N 6 alternate sensor position N5L/N6S which is also disposed closest to the N 4 position.
  • the second independent N 5 alternate sensor position N5M disposed furthest from the N 4 sensor position is utilized along with the second shared N s and N 6 alternate sensor position N5XL N6M which is also disposed furthest from the N 4 position.
  • the first shared N 5 and N 6 alternate sensor position N5L/N6S is utilized along with the first independent N 6 alternate sensor position N6L which is located closest to the N 4 sensor position.
  • the second shared N s and N 6 alternate sensor position N5XL N6M is utilized along with the second independent N 6 alternate sensor position disposed furthest from the N 4 sensor position.
  • the first and second shared N 5 and N 6 sensor positions function either as the N 5 or N 6 positions depending upon the size of torso the sensor mask is being utilized on.
  • the first shared N 5 -N 6 position f nctions as N 6 or N 5 , respectively.
  • the second shared N 5 -N 6 position functions as N 6 or N s , respectively.
  • the sensor set selected for performing the ECG on a specific patient is recorded for the taking of subsequent ECGs on that patient to insure repeatability of sensor placement.
  • the present invention also contemplates a method for obtaining an electrocardiogram, and a method of sensor placement for performing twelve-lead electrocardiograms, by means of a universal ECG multiple sensor dermal precordial mask incorporating sensors V N 2 , N 3 , N 4 , N 5 , and N 6 .
  • the mask is formed for fitting or accommodating different sizes of adult human bodies including extra large with repeatabiUty and clinical efficacy of sensor V l5 N 2 , N 3 , N 4 , N 5 , and N 6 placement irrespective of the varying human body torso sizes and the different distances between the human body
  • the method of sensor placement is comprised of several steps.
  • a mask is provided which is formed for clinically efficacious placement of six precordial sensors on a patient's chest irrespective of torso size.
  • the mask has a multipUcity of precordial sensor positions disposed in a specific geometrical pattern rather than in predetermined fixed arrays of individual sensor groups or an arbitrary individuaUy located array of six precordial sensors. As few as ten sensors can be utilized to serve as sensors for at least four different classes of human torso sizes.
  • the mask is provided with an arrangement of at least ten precordial sensor positions which are arranged in or form at least four sets of sensor groups of six sensors each. Certain of the sensor positions serve the same function in each of the sets, and at least two of the sensors serve as a different designated sensor in different sets.
  • the ten sensor positions are disposed in a specific geometric arrangement forming four sets of sensor groups which include four alternate sensor positions for each of the N 5 and N 6 sensor positions.
  • the V 1 - N 4 positions are utiUzed for all four sizes of bodies.
  • two sensor positions serve for either N 5 or N 6 in the four different sensor sets whereby four sets of six sensor positions each are provided by the ten sensor positions to locate sk of the sensors proximate the standard precordial anatomical landmarks of four different classes of sizes of human torsos.
  • the mask is provided with indicia for positioning it on a patient's sternum centerline and the fourth intercostal space and for deteraiining which sensor positions correspond to the four sensor sets.
  • the mask is placed on a patient's chest and the positioning indicia on the mask are aUgned with the corresponding anatomical positions on the patient's chest so that Ni and N 2 are disposed approximately on opposite sides of the patient's sternum.
  • Six of the ten sensor positions are then selected for performing an ECG depending upon the torso size of the patient by determining which one of the same designation sensors in each set lies closest to a selected precordial landmark whereby the set of sensors containing the closest lying sensor is selected as the set of six sensor positions to be utilized. In the preferred embodiment of the invention, this is done by ascertaining from the mask's indicia which of the four N 6 sensor positions Ues on or closest to the patient's midaxillary line.
  • Sensor leads from ECG test apparatus are connected to the corresponding set of sensors which include the identified N 6 position, and electrocardiographic information is obtained from those sensors.
  • both an apparatus and methods for torso sizing and sensor placement for performing twelve-lead electrocardiograms are provided, and the stated objects of the present invention are achieved.
  • a single mask design having only ten sensors instead of three or four different sizes of masks, as taught by the prior art, provides a universal size which can be utilized to obtain the benefits of simplified high volume production in order to lower the cost to the user and reduce the time previously needed to estabUsh the size of a patient.
  • the preferred embodiment of the present invention solves the problems associated with high variabiUty of individual sensor placement which may produce inaccurate ECGs, and thus an incorrect diagnosis, and which problems prevent valid and reliable serial comparisons between repeat ECGs on the same patient.
  • the present invention eliminates the logistics of maintaining different size sensor masks. This includes the stock in the central supply of a hospital, stock rooms of wards and clinics, and individual ECG carts. A related benefit is that stock would be depleted evenly thereby eliminating the possibility that some stock, e.g., a less often used size in a four-size system, might not be used prior to reaching an expiration date.
  • the one size design of the present invention eliminates the steps required to determine a patient's torso size and fits ninety-nine percent (99%) of the adult torso population including extra large. Any possibility of error when sizing a patient is eliminated.
  • the method of the present invention is one in which there is less waste since essentially all adult patients are accommodated by the one device. With more than one device size, there is the possibility that a wrong size would be apphed to a patient and would need to be removed and discarded prior to applying the correct size device. This trial and error situation would also increase the time spent performing an ECG on one patient. This is eliminated by the present invention.
  • the mask and method of use of the present invention in which the additional sensors with their respective adhesive areas increase the total area adhered to the patient. This will reduce the tension on each individual sensor since any puUing caused by respiration or from the ECG cable assembly wiU be shared by a greater number of sensors than would exist with a sk-sensor precordial pad.

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Abstract

L'invention porte sur un dispositif universel à jeter de positionnement des électrodes d'ECG et son procédé d'utilisation avec des équipements de diagnostic par ECG. Le dispositif consiste en un masque (11) muni de 10 électrodes dont 6 peuvent se poser à la fois. Il existe quatre tailles de masques correspondant à différentes tailles de torse.
PCT/US2002/039495 2001-12-13 2002-12-11 Dispositif universel de positionnement d'electrodes d'ecg pour quatre tailles dont extra-large, et procede associe WO2003051195A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2002362129A AU2002362129A1 (en) 2001-12-13 2002-12-11 A universal electrocardiogram sensor positioning device and method for four sizes including extra large

Applications Claiming Priority (2)

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US10/021,937 2001-12-13
US10/021,937 US6553246B1 (en) 1998-02-12 2001-12-13 Universal electrocardiogram sensor positioning device and method for four sizes including extra large

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WO2003051195A1 true WO2003051195A1 (fr) 2003-06-26

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